title: Anaemia management in patients with inflammatory bowel disease: routine practice across nine European countries.
abstract: OBJECTIVE
  Anaemia and iron deficiency (ID) are common complications in inflammatory bowel disease (IBD). In patients undergoing iron therapy, intravenous iron supplementation is recommended in preference to oral therapy. This study evaluated routine practice in the management of IBD-associated anaemia and ID to verify implementation of international treatment guidelines.
  
  
  METHODS
  Gastroenterologists from nine European countries (n=344) were surveyed about their last five IBD patients treated for anaemia (n=1404). Collected information included tests performed at anaemia diagnosis, haemoglobin (Hb) levels and iron status parameters, the anaemia treatment given and, if applicable, the iron administration route.
  
  
  RESULTS
  Selection of diagnostic tests and treatment for IBD-associated anaemia varied considerably across Europe. Anaemia and iron status were mainly assessed by Hb (88%) and serum ferritin (75%). Transferrin saturation was only tested in 25% of patients. At diagnosis of anaemia, 56% presented with at least moderate anaemia (Hb<10 g/dl) and 15% with severe anaemia (Hb<8 g/dl). ID (ferritin<30 ng/ml) was detected in 76%. Almost all patients (92%) received iron supplementation; however, only 28% received intravenous iron and 67% oral iron. Management practice was similar in 2009 and 2011.
  
  
  CONCLUSIONS
  In clinical practice, most IBD patients received oral iron even though this administration route may aggravate the disease, and despite international guidelines recommending intravenous administration as the preferred route. The high frequency of ID suggests insufficient monitoring of iron status in IBD patients. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.
authors.affiliation: aInterdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt am Main, Germany bDepartment of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark cDepartment of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden dDepartment of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria eVifor Pharma, Glattbrugg, Switzerland fDepartment of Gastroenterology, Hospital Charles Nicolle, Rouen, France gDepartment of Pharmacology and Therapeutics, Institute for Molecular Cell Biology, University of Porto, Porto, Portugal hDepartment of Gastroenterology, Centro Médico Teknon, Barcelona, Spain iDepartment of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands jDepartment of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Stein
authors.forename: Palle
authors.initials: P
authors.lastname: Bager
authors.forename: Ragnar
authors.initials: R
authors.lastname: Befrits
authors.forename: Christoph
authors.initials: C
authors.lastname: Gasche
authors.forename: Maja
authors.initials: M
authors.lastname: Gudehus
authors.forename: Eric
authors.initials: E
authors.lastname: Lerebours
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
authors.forename: Fermin
authors.initials: F
authors.lastname: Mearin
authors.forename: Daniell
authors.initials: D
authors.lastname: Mitchell
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D005293:Ferritins / Q000097:blood; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000453:epidemiology; D007501:Iron / Q000627:therapeutic use; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D014168:Transferrin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D014168:Transferrin; D005293:Ferritins; D007501:Iron